Is Crohn’s Disease Causing Your Skin Woes?

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Tasha Weinstein has been through the ringer since she was diagnosed with Crohn’s disease at the age of 11. Now 23, her experience with the inflammatory bowel disease has not only included the most common symptoms—such as persistent diarrhea, cramping, and other gastrointestinal symptoms—but also a memorable bout of erythema nodosum, the term for painful red bumps that appear on the legs of some people with Crohn's.

“I didn’t know what they were at first, but they looked like massive spider bites," the New York City-based sales executive says. "I couldn’t walk because it was so painful."

Weinstein is not alone. About 5 percent of people with an inflammatory bowel disease such as Crohn's will develop some skin complications, according to the Crohn's and Colitis Foundation of America (CCFA). Exactly who will develop skin issues with Crohn’s is not fully understood, but risks do include being female, being diagnosed with Crohn’s at a young age, and experiencing other non-digestive symptoms, called extraintestinal manifestations, according to a study published in the February 2014 issue of the Journal of Gastroenterology and Hepatology.

“Some skin issues are due to the underlying inflammation that causes Crohn’s disease, and some are due to its treatment,” says Misha Rosenbach, MD, an assistant professor of dermatology and internal medicine, director of the Dermatology Inpatient Consult Service, and the director of the Dermatology Urgent Care Clinic at the University of Pennsylvania in Philadelphia. “But regardless of the cause, skin disorders can be devastating to the patient. If you have Crohn’s and you see something new develop on your skin, it is worth questioning whether it is related to Crohn’s.” In many cases, more aggressive treatment of the Crohn’s disease can help clear your skin, Dr. Rosenbach adds.

Some of the more common skin issues that can occur with Crohn’s disease include:

Erythema nodosum. As Weinstein experienced, these red bumps can be tender, painful, and uncomfortable. “They form from inflammation in the fat and can be the first Crohn's disease symptom to emerge or appear in conjunction with a flare,” Rosenbach says. The good news is that these bumps tend to get better with tighter control of Crohn’s, he adds.

Pyoderma gangrenosum (PG).“These are big red blisters that can expand to painful ulcers that ooze pus,” says James Marion, MD, a professor of gastroenterology at the Icahn School of Medicine and a physician at the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai Hospital in New York City. About 1 percent of people with Crohn’s will develop PG, according to the CCFA. Complicating the situation even more, this serious condition is often misdiagnosed and treated as an infection. “We try to optimize treatment of Crohn’s in the face of PG as it can be a warning sign of a coming flare,” Dr. Marion says.

Skin tags.These are abnormal, typically small growths of skin. When they occur with Crohn’s disease, however, they often appear on the buttocks and tend to be larger and more painful than others, Marion says, adding that "they can really interfere with quality of life.” Skin tags develop from inflammation around the anal canal and tend to be worse during periods of heavy diarrhea. “We typically don’t remove them. Instead, we just dial up Crohn’s treatment,” he says.

Sores and fissures.“Crohn’s is a disease that affects the entire gastrointestinal tract, from the mouth to the anus,” Rosenbach says. This means there can be lip swelling, ulcers, or fissures (cuts or tears) in the mouth as well as in the anal area. “They are usually seen during severe flares and tend to get better when Crohn’s disease is under control,” he adds.

Skin issues related to Crohn’s treatment or surgery.Some Crohn’s disease skin problems are related to treatment, such as steroids that are used to get a flare under control, says Gary Goldenberg, MD, an assistant clinical professor of dermatology at the Icahn School of Medicine. “Steroids can thin the skin, causing stretch marks, and they can also affect hormone levels, which can cause breakouts,” he explains.

Crohn’s surgery that involves creating an alternate means of collecting stool outside the body can lead to various skin issues, too. “You may get a rash from the tape at the site of the pouch or an irritation from the stool's passage," Dr. Goldenberg says. "Or some people may be allergic to the adhesion material.” Working with a dermatologist can help you manage these issues.

Skin cancer.Immune-modulating drugs used to treat Crohn’s disease have been linked to some types of skin cancer, according to the CCFA. “If you have Crohn’s and are treated with an immune-modulating drug, see a dermatologist for a yearly skin check, be vigilant about checking your own skin, and always call if you see something suspicious,” Goldenberg says. It’s also important to apply broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher to help lower this risk, he adds.

“People with Crohn’s should consult a dermatologist along with their gastroenterologist to stay on top of all Crohn’s disease symptoms,” Goldenberg stresses.